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Perinatal Nurse Certification Examination Content Outline

This is a paper-and-pencil exam

There are 175 questions on this examination. Of these, 150 are scored questions and 25 are nonscored pretest questions. Questions are pretested to determine how well they perform before they are used in the scored portion of the examination. The pretest questions cannot be distinguished from those that will be scored, so it is important that a candidate answer all questions. However, a candidate's score is based solely on the 150 scored questions. Performance on pretest questions does not affect a candidate's score.

This Test Content Outline identifies the areas that are included on the examination. The percentage and number of questions in each of the major categories of the scored portion of the examination are also shown.

Category
Domains of Practice
No. of Questions
Percent
I
Issues and Trends
25
16.66%
II
Antepartum
25
16.66%
III
Intrapartum
25
16.66%
IV
Postpartum
25
16.66%
V
Neonatal
25
16.66%
VI
Management of High-Risk Pregnancy
25
16.66%
Total
150
99.96%

Note: All questions in categories II-VI are also are classified along a second dimension, Nursing Process. Thus, every question in these areas is classified first within the domain of practice that it tests. It then receives a second classification from the list below that indicates the step in the nursing process that it tests.

  1. Assessment/diagnosis
  2. Planning/intervention
  3. Evaluation

Test Content Outline

  1. Issues and Trends
    1. Preconception
      1. Pre-existing conditions
        1. Maternal medical disorders
        2. Genetic/hereditary disorders
        3. Infertility
      2. Teratogen exposure
        1. Environmental factors
        2. Medications
    2. Lifestyle
      1. Transcultural considerations
      2. Substance abuse
      3. Domestic violence
      4. Community resources
      5. Homelessness
      6. Nutrition
      7. Exercise
      8. Alternative therapies (e.g., herbal medicine, reflexology, massage, Reiki therapy)
      9. Other lifestyle issues
    3. Legal and ethical issues
      1. Standards of practice
      2. Nurse/physician/patient relationships
      3. Early discharge
      4. Communication
      5. Delegation
    4. Family planning and contraception
      1. Oral contraceptives
      2. Barrier methods
      3. Implantable and injectable contraception
      4. Other
    5. Application of theory to practice
      1. Nursing
      2. Change
      3. Motivational
      4. Other
    6. Leadership and management
      1. Leadership styles
      2. Performance appraisal
      3. Continuous quality improvement
    7. Research
      1. Critique of research studies
      2. Research utilization
      3. Research process

  2. Antepartum
    1. Adaptation to pregnancy
      1. Physical (by body system)
      2. Psychosocial
        1. Maternal role theories
        2. Adolescent growth and development
        3. Partner's role
        4. Family dynamics
    2. Management of normal pregnancy (including etiology, physiology, assessment, medical management, case management, and medications)
      1. Maternal and fetal risk assessment
        1. Risk scoring for pregnancy
        2. Previous prenatal history
        3. Previous labor history
        4. Health problems of other children
      2. Maternal and fetal testing
        1. Pelvic examination and fundal height
        2. Ultrasound examination
        3. Laboratory tests
          1. Serum glucose screening and oral glucose tolerance test
          2. Blood type, Rh factor, and antibody screening
          3. Maternal serum triple screen
          4. Complete blood count
          5. Urinalysis
          6. Culture for group B streptococcus
          7. Other (e.g., drug screening, serology, cultures and HIV)
        4. Amniocentesis
        5. Chorionic villi sampling (CVS)
        6. Fetal surveillance
          1. Fetal movement counts (FMC)
          2. Nonstress test (NST)
          3. Contraction stress test (CST)
          4. Biophysical profile (BPP)
          5. Fetal lung maturity studies
          6. Fetal heart rate
      3. Prenatal care
        1. Health history and physical assessment
        2. Nutrition
        3. Common complaints of pregnancy
        4. Therapeutic medications (e.g., vitamin, iron, or folic acid supplementation, Rho(D) immune globulin [RhoGAM])
      4. Patient and family education
        1. Alternatives in birth options
        2. Alternatives in health care provision
        3. Other
    3. Childbirth preparation and education

  3. Intrapartum
    1. Physiology of labor
      1. Powers (e.g., contractions)
      2. Passage (i.e., pelvis and supporting structures)
      3. Passenger (i.e., fetus)
      4. Psyche (e.g., coping mechanisms, cultural beliefs)
    2. Signs of labor
    3. Maternal response to labor
      1. Physiological (by body system)
      2. Psychosocial (by stage of labor)
    4. Fetal response to labor
      1. Fetal heart rate assessment
        1. Auscultation
        2. Electronic fetal monitoring
      2. Additional assessments
        1. Fetal scalp stimulation
        2. Vibroacoustic stimulation
    5. Labor (including nursing interventions)
      1. First stage
        1. Dilation and effacement
        2. Friedman curve
      2. Second stage
      3. Third stage
      4. Fourth stage
      5. Vaginal birth after cesarean section (VBAC)
    6. Labor induction and augmentation
      1. Cervical ripening techniques
      2. Induction
      3. Augmentation
      4. Active management of labor (AMOL)
    7. Operative interventions (indications and risks)
      1. Forceps delivery
      2. Vacuum extraction
      3. Episiotomy
      4. Cesarean birth and post-anesthesia care
    8. Pain management
      1. Pain theories
      2. Comfort measures and coping skills
      3. Analgesia (including patient-controlled epidural analgesia [PCEA], walking epidural, patient controlled analgesia [PCA], systemic medications and neuraxial analgesia)
      4. Anesthesia
        1. Local (local infiltration, dudenal, paracervical)
        2. Regional (epidural, spinal, combination spinal epidural [CSE])
        3. General
    9. Complications of labor and birth (including causes, assessment, management, and medications)
      1. First stage
        1. Chorioamnionitis
        2. Malpresentation and external version
        3. Uterine rupture
        4. Intrauterine resuscitation
        5. Amnioinfusion
        6. Cord prolapse
        7. Labor abnormalities/dystocia
          1. Protraction disorders
          2. Arrest disorders
      2. Second stage
        1. Arrest of descent
        2. Shoulder dystocia
        3. Nuchal cord
        4. Precipitous delivery
        5. Meconium
      3. Third stage
        1. Uterine inversion
        2. Abnormally adherent placenta
      4. Fourth stage
        1. Hemorrhage
          1. Uterine atony
          2. Laceration
          3. Hematoma
        2. Genitourinary trauma
        3. Endometritis
      5. Unexpected outcomes
        1. Alteration of birth plan
        2. Maternal-infant separation
        3. Maternal resuscitation
        4. Neonatal resuscitation
        5. Maternal death
        6. Fetal and neonatal death
        7. Partner and family response
        8. Infant with anomalies
        9. Amniotic fluid embolism

  4. Postpartum (including discharge planning, learning readiness, teaching priorities, and home care follow-up)
    1. Normal adaptation
      1. Physiological (by system)
      2. Laboratory evaluations (e.g., rubella, Rh antibody status)
    2. Family interactions (e.g., developmental tasks)
    3. Lactation
      1. Initiation and maintenance
      2. Problems (e.g., engorgement, cracked nipples, clogged ducts, breast-pumping difficulties)
      3. Management of nonlactating breasts
      4. Patient teaching and support
      5. Contraindications to breastfeeding
      6. Composition of breast milk
    4. Perineal care
    5. Pain management
      1. Patient-controlled analgesia (PCA)
      2. Continuous epidural
      3. Other (systemic medication medications, nonpharmacologic methods)
    6. Complications (including causes, assessment, management, and medications)
      1. Genitourinary system
        1. Subinvolution
        2. Late hemorrhage
        3. Infections
      2. Mastitis and breast abscess
      3. Embolism
        1. Thrombophlebitis
        2. Pulmonary embolism
        3. Other
      4. Depression and psychosis
      5. Sepsis
      6. Other

  5. Neonatal
    1. Normal adaptation
      1. Physiological (by system)
      2. Psychosocial (e.g., infant behavior cues, prolonged hospitalization)
    2. Postbirth care
      1. Thermal regulation
      2. Initial assessment, stabilization, and resuscitation
        1. Term infant
        2. Preterm infant
        3. Infant with special needs
      3. Apgar scoring
      4. Blood gases
        1. Umbilical cord blood gases
        2. Neonatal blood gases
      5. Medication and immunization (eye prophylaxis, vitamin K administration, hepatitis B vaccine, Hbig, and antiviral)
      6. Family-infant attachment
      7. Screening exams (PKU, hearing)
      8. Circumcision
      9. Drug screening
    3. Neonatal development
      1. Gestational age assessment
      2. Behavioral states
    4. Nutrition
      1. Early feeding cues
      2. Breastfeeding
      3. Bottle-feeding
      4. Special feeding needs
    5. Family education
      1. Nutrition
      2. Safety
      3. Well-baby care and immunizations
      4. Infant care (e.g., temperature-taking, bathing, skin care)
      5. Preterm/term growth and development
      6. Prevention and recognition of infections and other illnesses
      7. Teaching-learning theories
    6. Complications (including causes, assessment, management, and medications)
      1. Congenital defects
      2. Neurological
        1. Asphyxia
        2. Intraventricular hemorrhage
        3. Seizure disorders
      3. Respiratory conditions
        1. Apnea
        2. Respiratory distress syndrome
        3. Meconium aspiration syndrome
        4. Blood aspiration syndrome
        5. Pneumothorax
        6. Diaphragmatic hernia
      4. Cardiac conditions and hemoglobinopathies
        1. Congenital heart lesions
        2. Anemias
        3. Polycythemia
        4. Heart murmurs
        5. Coagulopathies
      5. Infants of diabetic mothers
      6. Gastrointestinal and genitourinary conditions
        1. Feeding disorders
        2. Hyperbilirubinemia
        3. Hypoglycemia
        4. Hypocalcemia
        5. Necrotizing enterocolitis
        6. Other
      7. Musculoskeletal and skin conditions
        1. Birth trauma
        2. Rashes and birthmarks
        3. Other
      8. Infections
        1. Group B streptococcus
        2. Hepatitis
        3. Human immunodeficiency virus
        4. TORCH
        5. Sexually transmitted diseases
        6. Nosocomial
        7. Other
      9. Neonatal substance withdrawal

  6. Management of High-Risk Pregnancy (including etiology, pathophysiology, assessment, medical management, case management, and medications during antepartum, intrapartum, and postpartum periods)
    1. Hypertensive disorders
      1. Chronic
      2. Pregnancy-induced/gestational hypertension (PIH)
        1. Preeclampsia
        2. Eclampsia
        3. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome
    2. Diabetes mellitus
      1. Type I and type II
      2. Gestational
    3. Bleeding disorders
      1. Spontaneous abortion
      2. Ectopic pregnancy
      3. Hydatidiform mole
      4. Placenta previa
      5. Abruptio placentae
      6. Coagulation disorders (idiopathic thrombocytopenia purpura [ITP], TTP, Factor XIII- Von Willebran)
      7. Hemoglobinopathies (e.g., sickle cell anemia and thalesemias)
    4. Preterm gestation
      1. Preterm birth prevention
      2. Preterm labor
        1. Expectant management
        2. Inpatient management
        3. Outpatient management
        4. Medications
      3. Incompetent cervix
    5. Postterm gestation
    6. Premature rupture of membranes
    7. Amniotic fluid disorders
      1. Oligohydramnios
      2. Polyhydramnios
    8. Maternal transport and transfer
    9. Other
      1. Multiple gestation
      2. Cardiac disease (e.g., congenital, acquired, ischemic)
      3. Pulmonary disorders (e.g., asthma, pneumonia, pulmonary embolus)
      4. Renal disorders (e.g., urinary tract infection, pyelonephritis, kidney stones)
      5. Eating disorders
      6. Gastrointestinal disorders (e.g., hyperemesis, Crohn's disease, gallstones, appendicitis)
      7. Rh and ABO incompatibilities
      8. Abortion (e.g., spontaneous, therapeutic, septic)
      9. Autoimmune disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis)
      10. Thyroid disorders
      11. Neuromuscular disorders (e.g., seizures, multiple sclerosis, spinal cord injuries)
      12. Infections (e.g., TORCH, sexually transmitted diseases, human immunodeficiency virus, group B streptococcus)
      13. Cancer
      14. Intrauterine growth retardation (IUGR)
      15. Trauma
      16. Advanced maternal age
      17. Adolescent pregnancy
      18. Factor V lieden (protein S and protein C deficiencies)

This page last revised 1/24/2007.